The link between menopause, osteoporosis and Exercise therapy

Strategies to improve your bone health

Have you heard about weak bones and menopause? How and why does it happen?

Well, our aim here is to educate women about this silent disease called Osteoporosis, which affects over 200 million people worldwide. Educating women during perimenopausal (years leading to menopause) as well as menopausal years will help them to prevent this condition.

Most commonly this condition is diagnosed after an injury in which you may have suffered a fracture.

Know why Bone loss happens :

The production of cells causing absorption or dissolution of the bone increases as compared to the cells helping with bone formation. The bones become more fragile and increase the likelihood of fractures. These changes happen due to a decrease in estrogen levels during menopause.

Apart from medications, numerous studies have shown that bone health programs that comprise weight-bearing exercises, strength training, fall prevention strategies and lifestyle management will help to slow bone loss, even build bones.

Bone-strengthening program

An exercise program for osteoporosis should include:

  • Weight-bearing exercises : The muscles and tendons apply tension or stress to the bones, it gets stimulated to produce more tissue by depositing extra calcium and nudge those bone forming cells. As the bone becomes stronger and more denser, the risk of osteoporosis and fractures decreases. What activities you can do:
    • Walking
    • Climbing stairs
    • Playing sports and dancing
    • Higher impact activities build stronger bones.

  • Muscle-strengthening exercises
    • Bodyweight exercises such as lunges, squats or resisted exercises using bands, dumbells, weight machines will help to build muscle strength as well the bone density. Do these types of exercises at least twice a week.

  • Balance exercises: Balance exercises improves your ability to prevent falls. Exercises such as Tai Chi, yoga are very helpful.

  • Flexibility exercises Helps to keep your joints mobile. You may perform yoga, or stretching exercises every day as part of mobility routine. keep your muscles limber and joints mobile.
  • Lifestyle modification is key to healthy wellbeing. Eat fresh vegetables and fruits, whole grains, exercise daily, take your supplements such as Vitamin D, Calcium, Stop smoking, limit alcohol consumption, Have a good sleep routine and meditate.

As a woman, we all will be going through this phase of menopause, but getting to know what to expect and how to prevent the problems which may occur, will help us to transition into this phase stronger and smarter.

Happy Women’s Day to all!

Happy Women’s day

It is the most awaited day of the year- International Women’s day 

Every year on the 08th of March we celebrate this day to celebrate “Us”-Women

Women have definitely come far in terms of seeking equality in society since the 1800s. However there is still a requirement of education about our health in each and every stage of our life.

Be it adolescence, adulthood, motherhood, or menopausal stages of our life… 

1. During adolescence/Puberty – The body is raging with hormones and developing sexual function. If the adolescent is malnourished and inactive this affects the bone growth and may lead to poor absorption of nutrients and poor bone + skeletal growth. This will affect their future life.

2. During adulthood, healthy nutrition as well exercise are essential. If the female is pregnant then iron, calcium and Vitamin D are suggested along with balanced cardiovascular exercises such as walking, cycling or if you are a runner to continue with pre pregnancy exercises. Pregnant women are also suggested to focus on yoga and or Pilates for improving pelvic floor health.

3. Post pregnancy/breastfeeding stage, continuing Vitamin D, calcium and multivitamins to maintain the physical health along with balanced cardiovascular and strength exercises are recommended. First 6 months – post-delivery are crucial to regain the pre pregnancy fitness levels and continuing both types of activities.

4. Bone health is extremely vital for women’s health as the age progresses.  Healthy diet along with weight bearing + strength exercises such as gym exercises, Pilates, yoga, along with cardiovascular exercises such as walking, running or cycling are suggested. 

5. Vitamin D supplements are suggested to improve bone health and include the same via nutrition in terms of green leafy vegetables, low fat cheese, eggs, low fat milk and low fat yoghurt are recommended.

6. Maintaining healthy body weight is extremely important to avoid low back pain, knee pain arising from carrying extra weight on these weight bearing joints. Also as we age we store more fat than muscle mass in our body, hence it is advisable to build muscle mass by doing resistance exercises for better aging.

7. Although our bodies are resilient that go through monthly period pains, pregnancy, and menopause etc. we need to take care of this robust body by doing regular exercise and supplementing our food with supplements/ multivitamins, colourful foods( more colour on your plate the better ) in our diet for a healthy and long life.

8. We look after others all the time and now it’s time to take care of ourselves!! Lastly, do not forget about self-care and mental health, you are amazing, strong, beautiful and you are doing great!! Keep it up!!

Sam Bhide

Owner/Clinical Director of Physiozen 

Physiotherapy, wellness and fitness service 

United Kingdom

Easing back pain while breastfeeding

I held my bundle of joy 3 months ago and every minute since then has been a new learning experience. I had challenges while feeding my first baby, hence this time around I decided to plan ahead to make it easier on my body.

Breastfeeding is a multifaceted skill. While trying to comfort the baby we often ignore how postural stress might be affecting our bodies.

Breastfeeding my babies was wonderful but challenging too. My back and neck took a toll while being in an awkward position sometimes.

To relieve aches and pains I implemented some strategies such as posture correction, feeding positions, exercises to stretch and strengthen the muscles to relieve the symptoms.

My tip: Breastfeeding shouldn’t be painful!

I am sharing some easy tricks and tips which helped me ease the pain and prevented it from recurring.


Sitting on a comfortable chair with your back, and feet supported is very important. Use a small pillow behind your back if the chair doesn’t give you enough lumbar support. The feet should be flat on the ground. 

2. Use a feeding pillow and a simple hack that I found useful was to put a small towel folded under the headend of the pillow so the baby is in a propped up optimal position and you won’t hunch over to feed. Let baby come to your breast instead of you leaning forward to feed.

3. Try different feeding positions.

In the daytime, you can try feeding the baby on the bed lying on your side to ease stress over the lower back.

Your breasts need support too. Wear a good quality bra.

4. Simple stretches and exercises to strengthen your back. Try these mobility exercises 2 to 3 times a day.

5. Deep breathing helps to relax your whole body. Breath in through your nose and breath out through your mouth.

Some add ons: Heat pack, massage, take a break and rest by pumping and bottle feeding, always take help when offered, and most important hydrate!!

Prevention is better than cure.


The above tips are not a substitute for medical advice please seek a medical professional if the pain is severe and you are experiencing tingling, numbness in your arms and legs.

Embracing the Fourth Trimester

Here comes the fourth trimester! After three blissful trimesters of pregnancy, it’s time to give some extra care to this one. The fourth trimester is the postpartum period. But trust me, this doesn’t just get over after 12 weeks.

Postpartum is forever! We all work hard to make sure we are eating right, exercising, staying happy but as soon as we deliver the whole world revolves around a beautiful baby you created.

A postpartum plan is as important as having a birth plan. 

How to take care of yourself while taking care of a new baby?

The best way is to plan ahead. It’s a great idea to enrol yourself in a program that can guide you on how your body is changing post-delivery and how to cope with daily stressors and work towards a stronger self.

Here are some tips :

  • Set aside 15 min for yourself each day. 
  • Perform some week appropriate light exercises instead of rushing to the gym and starting a workout. Talk to a postnatal fitness specialist.
  • Work on your posture while you are feeding, lifting the baby or performing your day to day activities.
  • Meditate.
  • Take help when offered.
  • It’s ok to take a break and sneak out for some self-care such as going for a spa or massage.
  • See a pelvic floor physical therapist if you are experiencing any pelvic floor symptoms.
  • Most importantly embrace your body as you embrace motherhood.

Happy mother = Happy baby

Are you a physiotherapy graduate and wondering what is the best career choice for you?

Physiotherapy career choices
Physiotherapy career choices

Whether you are a newly qualified physiotherapist or someone with years of experience you should always look for opportunities to develop in your career. This is what I do, like everyone I started at the bottom of the ladder and since been working towards developing in my career. 

I am often asked by newly qualified physiotherapists, colleagues and friends about what should be their next step in their career. So I thought I will put down my top 5 career choices.

They are 

  1. Musculoskeletal & Sports Physiotherapist
  2. Respiratory Physiotherapist
  3. Rehabilitation Specialist
  4. Clinical Lead
  5. First Contact Practitioner(FCP)
  1. Musculoskeletal & Sports Physiotherapist: If you are passionate about sports and have always wanted to know what every muscle, bone, ligament and tendon combination can do, then this could be for you. 

You can work in out-patient units, independent clinics or in the community.

Pros: You’ll be able to see results within specific periods. And there could be some employers who might not want you to work on weekends. But remember the best exposure in sports happens over weekends.

Cons: Working in this field for a long term can become physically exhausting after a few years so it is very important to take it easy on yourself. 

  1. Respiratory Physiotherapist: If you are someone who wants to make a difference when it could be a life or death situation-this is for you. Your contribution can be immense for those who are struggling with their breathing and mobilisation.

You can work in wards, intensive care units and step down respiratory centres.

Pros: Compared to MSK, respiratory can be less physically demanding as you tend to find help from other staff in ICU and wards. As you work in ever demanding critical care units, it can make you stronger as an individual.

Cons: You definitely have to forget weekends and be prepared for on-call and night duties.

  1. Rehabilitation Specialist: Do you like giving your best and getting involved with the journey of your patient’s recovery? Then this can be you. 

You can work in both Sports, Orthopaedic and Neuro outpatient departments or rehab centres.

Pros: As a rehab specialist, you will be developing your skills by attending various multidisciplinary CPD (continuing professional development). You will be able to independently plan your patient’s recovery program.

Cons: Rehab specialists can become mentally exhaustive; you may struggle to stay motivated esp. with patients expecting passive treatment.

  1. Clinical Lead: This is for the ones who have worked in most of the physiotherapy specialties with extended qualifications and are looking to take the profession to a high standard. If you are a people’s person and passionate about your profession, you can progress in your career by improving the service of physiotherapy in hospitals and the healthcare industry. 

Pros: Working at this level helps you master your emotional intelligence and networking. 

Cons: This role may demand working longer hours with more responsibilities which in return may induce stress.

  1. First Contact Practitioner(FCP): This is the most recent career option available in the UK. You are required to have experience across most physiotherapy specialties and good interpersonal skills. You can also train yourself to become a FCP. 

These practitioners work out from GP practices and can address any MSK related issues in place of a GP.

Pros: As a first contact practitioner you will be exposed to a variety of MSK and non medical cases. This will help you to develop as a better clinician.

Cons: It can be highly demanding and sometimes stressful.

These are just a few from the vast list you could choose. As a profession physiotherapy is blessed with multiple opportunities in each speciality so don’t feel shy to come out of your comfort zone. Leave us a comment if you would like to hear about more opportunities.

Pain Catastrophizing Behavior

Pain catastrophizing and Recovery from Chronic Pain

Pain Catastrophizing behavior:

Catastrophizing of pain is a negative thought process, a feeling of complete denial of recovery where the individual begins to live life with pain. It has resulted in restricted social participation, reduced pace of work and activities of daily living as a result of  a constant fear of motion. A feeling of continuous stress of not being able to carry out an activity without pain often results in anxiety and in some cases a state of depression as well when pain ultimately causes disability.

Pain perception is one of the most important aspects of investigation and diagnosis of chronic pain. Fear-avoidance and catastrophization shapes the cognitive response to persistent pain. These responses are often emotional and behavioral outcomes that have been largely affecting the recovery rate.

The fear-avoidance model:

Avoidance is a human way of escaping danger. However, we are unaware of the fact that it is even more dangerous to avoid an activity in fear of getting hurt. Avoiding the use of the body part causing pain perpetuates the abnormal pain behavior resulting in a long term disability even in the absence of an underlying pathological cause.

The fear-avoidance model by J.W. Vlaeyen and S.J. Linton, 2000 describes the consequences of pain-related fear and pathway of recovery.

Movement related fear of pain after injury causes disuse and at last disability on catastrophizing for a prolonged period of time. What becomes more dangerous than the injury itself is the exaggeration of its effects and pessimism to recover from the injury. A negative thought process by an injured individual about what has happened and prediction of false future consequences out of fear can drastically increase the intensity and frequency of an acute pain and might not take a long time in converting the acute pain into persistent and finally chronic pain.

At the stage of chronic pain, the injury is often healed but the fear persists.

The fear of pain often results in reduced work capacity, increased absenteeism, low social interaction, reduced productivity etc. in many cases it has also resulted in negative body image and overthinking affecting interpersonal relationships along with work.

A negative perception of pain is often related to past experiences of pain, traditional and cultural influences and trial and error. Understanding of pain from such perspectives often gives a false belief to the individuals dealing with pain creating a cycle of negative thought process, catastrophization, fear-avoidance behavior, diause and disability.

Risk factors associated with chronic pain:

There are several individual, physical and psychological risk factors that are associated with the development of chronic pain. These factors are often not addressed as when the biomedical model of investigation and management is used. Adaptation of the biopsychosocial model of pain on the other hand has shown to increase early detection of factors causing pain and elimination of such factors. Psychological and social risk factors have often played a larger role in chronic pain investigation and treatment. For example, the work environment, work load, interpersonal relationships, social support and interaction. Understanding of the risk factors often paves the way for better recovery in such cases due to identification of the exact cause of pain. However, the method is still not used widely.

The waves of behavioral therapies to combat chronic pain:

The first wave of behavioral and cognitive therapy was the Traditional behavior therapy, which aimed at replacing harmful behavior with constructive ones through conditioning.

The second wave focused on thought changing concepts in which the negative pain related thoughts were discouraged.

The third wave is about behaviorism, spirituality, mindfulness, centering, dialectics and relationship building.

The waves of behavioral and cognitive therapies preferred over time gives us an idea about how pain has been perceived at different points in time by analyzing the approaches used to treat pain related behavior. Adaptation of cognitive and behavioral approaches for recovering from chronic pain needs more attention and modifications. The primary aim of treating chronic pain must be identification of the predisposing risk factors followed by planning a goal-oriented management approach highlighting the emotional and psychosocial aspects. A positive thinking about recovery from pain has resulted in increased rate and early recovery. Breaking of the fear-avoidance cycle is an important aspect of chronic pain management which incorporates a major role of pain education on the basis of evidence based practice.

Thank you.

Dr. Jasrah Javed (PT)

Musculoskeletal and Sports Physiotherapist, Author

Exercise: Key to your mental health!

“Exercise keeps me occupied, which is good for my mental health!”-Gail Porter.

Exercise ensures successful brain functioning. There is a long history of how our ancestors knew the importance of fitness and maintaining an active lifestyle. Some studies suggest that this relationship is a part of the evolutionary process as physical activity is associated with survival. There has been overwhelming evidence of how exercise helps in delaying or preventing the neurodegenerative changes in the brain and also helps in improving mental health.

How does exercise help?

  1. Depression: It is said the exercise is the most underutilized drug for depression! Various studies have supported the role of exercise to improve symptoms of depression. The reason is attributed to the secretion of neurotransmitters like serotonin and endogenous morphine which produce a state of euphoria.
  2. Anxiety: High-intensity exercise has shown to improve anxiety. 20 to 30 minutes of aerobic exercise has a positive effect. Some hypothesis behind the positive effect is increased in temperature causes a decrease in muscle tension. Another possible reason is the activation of the sympathetic nervous system causing an increase in adrenaline. This provides a catalyst for the parasympathetic nervous system and the acetylcholine released causes the calming effect.
  3. Cognitive functioning: It’s an important party of mental health and well being. Regional cerebral blood flow improves with exercise causing an increase in glucose uptake and oxygen. All this will help to improve the cerebral activity.

Incorporate 20 to 30 minutes every day and perform some sort of exercise. Aerobics in form of walking, dancing, jogging, biking. Include strengthening exercises in your routine 2-3 times per week.

It’s never too late to start exercises and continue doing them as a routine. “Sound mind resides in a sound body”!


Ways to ease mommy’s thumb

Happiness has no bounds when you cuddle and hold your baby. We read all the blogs, books and pages on the internet, to update ourselves on how to take care of the baby. But sometimes we forget to know those tips and tricks to prevent aches and pains post-pregnancy. Postpartum or post-pregnancy there are so many changes still happening in the body due to hormones.

Painful wrist and thumb are very commonly seen in new moms and even dads due to repetitive action of picking up and holding the baby, changing the diaper, putting in and out of car seat etc.

Definitely, we want you to continue doing these activities as its best way to bond with the baby, but let’s look into the causes of those aches and pains you may be having and prevent, self test and ease them before it becomes a ongoing problem.

What is Mommy’s thumb/ Dequirvain’s Tendinitis

Mommy’s thumb or Dequirvain’s tendinitis is inflammation of tendons around your thumb and wrist. Pain is typically dull achy and the area near the thumb is tender to touch. You might notice swelling, redness or warmth in acute phase.

How to self test

Check out this video to self assess the reason for your pain.

How to ease the pain

  • Icepack: Icepack works wonders in the acute phase of inflammation. If the pain is chronic for more than 3-4 weeks and you do not notice any warmth or swelling, you may use a heating pack.
  • Gentle range of motion: You do not want your thumb to get stiff. Gentle movements help to improve blood circulation and ease stiffness.
  • As pain improves start with some exercises to strengthen your finger and thumb and wrist muscles.
  • If pain is severe you may briefly use a splint or brace to prevent stress.
  • See a physical therapist, get your condition assessed properly and treat it before it becomes a chronic condition.

Tips to prevent painful thumb

Prevention is always better than cure!

  • Follow right body mechanics while lifting the baby. So instead of picking up the baby u holding under the arms by stretching your thumb out, try scooping the baby under the bottom by keeping your palms facing up and wrist neutral.
  • Follow right body mechanics while lifting the baby. So instead of picking up the baby u holding under the arms by stretching your thumb out, try scooping the baby under the bottom by keeping your palms facing up and wrist neutral.

Happy motherhood!

Why Physiotherapy does not work for everyone?

Have you ever wondered why some people say Physiotherapy did not work for them?

A big part of my clinical consultation involves talking to patients who have been struggling to recover from their injuries or Physiotherapy did not work for them in the past.

The most common reason for this could be either you are pushing yourself too much or you did not get the right Physio.

Whenever you have an injury, like any other disease or condition, you need time to recover. 

Even if it is a mild cold, it does not disappear in a day, does it? So it is the same with any musculoskeletal injury. Normally soft tissue injury can take 6 weeks or more to recover and if you have a fracture, complete recovery can take upto 12 weeks (depending on the bone you fracture).

Damage to the soft tissues(muscle, ligament, tendons) causes inflammation around that area and you can have signs like redness, warmth, swelling, pain and sometimes bruises. 

Let’s make it more simple, imagine you had a cut while working in the kitchen or deep scratch while walking in the woods. Like how these cuts or scratches do not heal in a day, likewise any other injuries need time to heal. 

If you are an active person, it becomes very hard to rest or avoid the sports or activities you love to do. However, it is very important to pace your recovery program. 

Expecting to return to sports or your regular activities too soon because the signs of inflammation have come down can be one of the greatest mistakes that you can make. Once the signs of inflammation are reduced, you need to gradually start building up muscle strength and flexibility. This will prevent excessive loading of the muscle too soon which can lead to irreparable damage.

Some patients that I talk to often refer to seeing Physiotherapists for weeks with no improvement and are just looking for surgical options. I like taking very detailed consultation with such patients as it often turns out that the Physiotherapy program that they were provided was either machine-based passive treatment or too basic or very intensive exercise program.

That is why it is very important to design a customised program as each individual is different. And that can be achieved if we listen to our patients and let them set their goals.

So if you have any ongoing or recurrent pain, please comment and connect.

Riding a tide called motherhood!

Tips from a stay at home mom, a working mother and a grandmother

Motherhood is a fusion of emotions. A mixed bag of sentiments such as joy, the feeling of accomplishments, sometimes guilt and uncertainty. But as years pass by we realize it’s all about how to balance this ride!

The month of March is dedicated to all amazing women. I got the privilege to interview three wonderful mothers. And I am excited to share their perspectives on motherhood.

Meet Pallavi Sapre 41-year-old, Mother of two and a stay at home mom

Question: How long have you been a stay at home mother and what prompted you to stay home with the kids?

Answer: I have been a stay at home mom for 14yrs. I decided to stay at home due to circumstances during and after pregnancy. I somehow couldn’t get back to work as I had my second baby.

Question: What do you think about working moms?

Answer: I have tremendous respect for working moms who can manage both work and family.

Question: What do you do all day and how you plan it?
Answer: Most of my day revolves around the girl’s schedule. Once I get my time then I do some exercise, watch T.V, read, go for a walk with friends, play badminton… etc.

Question: What is the best part of being a stay at home mother?
Answer: It has its perks. I get to stay with my kids all the time…. literally. I enjoyed each moment watching them grow, reaching each and every milestone. This is something I would love to cherish all my life.

Question: What is the piece of advice you would give to another mom who is contemplating becoming a stay at home mom?
Answer: There is no harm in becoming a stay at home mom but don’t get too comfortable with that role that you may not be able to come out of it. Enjoy it fully but at the same time keep in mind that one day you need to get back to work. This is very important as after a few years children will get busy with their own lives.

Question: What do you do to keep your mind and body fit?
Answer: For physical fitness, I play badminton, gym workouts, dance and for my mental wellbeing I go for walk with friends, read books.

Meet Nancy Hsu 42-year-old, Mother of two, Program manager.

Question:  Do you think it is easier or harder to be a working mom?

I feel its both, harder because you are juggling too many things same time. But for me personally, I feel easier as it helps me to stay mentally and emotionally healthier. 

Question: How do you manage the busy schedule, being a wife, mother and working in office?

My mother and husband help me to manage the day. I believe in taking one thing at a time and not get overwhelmed. And when things go bad just let it go.

Question: What is one thing you would like to do more often? 

Working out and having a exercise routine is something I would like to do more often.

Question: What is that one thing you would have done differently as a working mom?

I always wished to have dinner with my family which I often missed due to work and travel. This Pandemic made it possible for me to sit with my family for dinner every single day!

Question: What is the best parenting advice and relationship tips you would offer to other working moms?

Accept help if someone offers. For a successful relationship, its very important you spent quality time with your partner. Focus on what will matter to you after 10 or 20 years. It’s ok to not clean the house one day and spend time doing what you like. For me its spending time with my kids as I know they will soon go to college so each minute I want to make it a memorable one.

Question: What do you do to keep your mind and body fit?

Regular workouts, reading, watching TV, play board games with kids and spend quality time with family and friends. 

Meet Maria Damas, 72-year-old loving mother and a grandmother

Question: You raised 4 kids while your husband travelled for work?? How did you manage everything without losing your mind?

 Answer: I lived in El Salvador. My day started early at 5 AM before the kids woke up. I kept things ready for them and once they went to school I went to the gym to make sure I stay fit. While heading back home from the gym I bought fresh produce and groceries and cooked for my family homemade food. After kids were back from school remaining day was spent helping them with homework, cooking the evening meal and once the kids were off to bed I spent some time “me time” again by reading a book, watching T.V.

Question: What do you think you see parents worry too much these days?

Answer: Kids have easy access to gadgets and technology, and I feel this is what makes parents more worried as they have to be vigilant all the time. I feel back then we had more control over our kids but this might be due to cultural difference in different countries.

Question: What is your best advise to your kids at this point in their life?

Answer: To dedicate more time to kids as they are young and save money to prepare for a better future.

Question: What is your biggest piece of advice for mothers raising children today?

Answer: Discipline and sticking to the rules is very important .

 Question: What do you do to keep your mind and body fit?

Answer: I maintain my schedule and eat healthy food, I do not miss going for a walk, read books, relax and not to get involved in other people’s business.

It was a great privilege to be able to interview three powerful mothers. I realized each one of them has a very positive outlook on their choices of the role they took in their life. The stress on self-care and “living in the moment” is something that touched my heart.

I hope their outlook towards life, parenting and self-care will give you an opportunity to look into a new perspective and bring new light into your life and relationships with your family and with yourself.

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